Provider Demographics
NPI:1518919349
Name:HANNAN, PATRICIA M (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HANNAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 10TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0100
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:706-737-2271
Practice Address - Street 1:110 PEPPER HILL WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2818
Practice Address - Country:US
Practice Address - Phone:803-642-6060
Practice Address - Fax:706-228-3433
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2288367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00880OtherUPIN
SCAN0591Medicaid
SCP00381398OtherRAILROAD MEDICARE
SCQ322287577Medicare PIN
SCP00381398OtherRAILROAD MEDICARE